Healthcare Provider Details

I. General information

NPI: 1265991418
Provider Name (Legal Business Name): DEBRA L. REZENDES PH.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W NEW HOPE DR
CEDAR PARK TX
78613-2799
US

IV. Provider business mailing address

821 W NEW HOPE DR
CEDAR PARK TX
78613-2799
US

V. Phone/Fax

Practice location:
  • Phone: 571-585-4616
  • Fax:
Mailing address:
  • Phone: 571-585-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001874
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: